Sentinel lymph node (SLN) biopsy was successfully used to assess lymph node status in women with early-stage endometrial cancer, suggesting that this minimally invasive procedure can be a safe and effective alternative to more extensive lymph node removal.
Although lymphadenectomy helps to determine cancer metastasis and identify the most effective treatment plan for persons with the disease, it has shown little benefit in women with early-stage endometrial cancer. In addition, the surgery is associated with increased risk of lymphedema and other complications.
Between July 2007 and August 2009, 133 women with early-stage endometrial cancer underwent SLN biopsy followed by complete lymphadenectomy of all pelvic lymph nodes as participants in France’s SENTI-ENDO trial. At least 1 SN was detected in 111 of 125 eligible patients. No surgical complications were reported during SLN biopsy, even when the procedure involved conversion to open surgery.
SLN was successful in 77% of cases in the right hemipelvis and in 76% in the left hemipelvis, demonstrating an overall detection rate of 98%. Using the hemipelvis as the unit of analysis, negative predictive value (NPV)—the probability that persons who test negative are correctly diagnosed) was 100% (no false-negative cases were recorded) and sensitivity (rate of true positives) was 100%. Using the patient as the unit of analysis, SLN biopsy produced an NPV of 97% and sensitivity of 84%.
In their report, published online ahead of print by The Lancet Oncology, Marcos Ballester, MD, of the obstetrics and gynecology department of Tenon University Hospital in Paris, and colleagues acknowledge that further studies are needed to evaluate cost-effectiveness, effects on adjuvant therapies, and quality-of-life-issues associated with the SLN biopsy. However, they conclude, “The SLN procedure provides data to tailor adjuvant therapy without increasing the risk of intraoperative and postoperative complications. Therefore, the SLN procedure alone could be recommended for low-risk and intermediate-risk endometrial cancer.”